As we leave the doldrums of winter and enter into the awakening of a new spring era, we often become motivated to clean up and clean out. We clean out the garage, the basement, the closets and start opening the windows and letting the fresh air permeate the stale winter environment of our homes.

Today, as you contemplate those spring-cleaning duties, I would like to have you contemplate another area that you must clean up: the inside of your “oral cavity.” You see, we are now learning more about the importance of oral hygiene and its impact on brain and cardiovascular health.

Full confession: I have always felt strongly about the relationship between oral health and one’s overall health and wellness. Another confession is that, after receiving my undergraduate degree in biology, I applied for and was accepted at a dental school in Washington D.C.. After much consideration and introspection, however, I decided instead to pursue a career that was more holistic in its approach to overall health and wellness and moved to Iowa to attend Palmer College of Chiropractic. The holistic philosophy of chiropractic was more aligned with my deep interest in nutrition, biochemistry, and lifestyle than conventional medical practice. After 4 years of undergraduate education and beginning for a short term working towards Master’s Degree program, I felt I had finally found an educational program that aligned with my holistic and functional healthcare beliefs and goals. In the 45 years since, I have had the opportunity to help and care for thousands of patients through hands-on techniques that I felt were the best for my patients overall health and longevity.

However, along that journey, I have never lost sight of the fact that oral health is key to a person’s overall systemic health and thereby their functional longevity. To that end, I want to share with you recent research that has demonstrated that poor oral hygiene can nearly double your risk of stroke and can also have a significant impact on brain health, including damage to the brain, memory problems, and slowing of cognitive function. 

RESEARCH SUPPORTS THE NEED TO KEEP YOUR MOUTH CLEAN

An article published in Neurology Open Access, which is the journal of the American Academy of Neurology, described the findings of a recent study. In the article titled, “Combined Influence of Dental Caries and Periodontal Disease on Ischemic Stroke Risk,” the authors wrote, “Co-occurring periodontal disease and dental caries [cavities] were independently associated with increased risk of ischemic stroke and MACE [major adverse cardiovascular events].” They went on to state, “Regular dental care may reduce the risk by improving oral health. Limitations include reliance on one-time dental assessment and residual confounding.”

So, the researchers found that cavities and gum disease both and independently would increase your risk of having a MAJOR cardiovascular incident and a stroke. They noted that the combination of periodontal disease and cavities doubles the risk of stroke. They also found that you should not just rely on your annual or semi-annual visit to your dentist for teeth cleaning and evaluation and then expect that everything will be alright. In other words, you need to keep your mouth consistently clean.

Let’s clarify these findings and the statistics further. The authors found that people with both gum disease along with cavities had an 86 percent higher risk of stroke because of blood clots that formed. They also had a 36 percent higher risk of heart attacks and heart disease, including heart failure, when compared with those with healthy mouths. Having gum disease alone caused a 44 percent increase in stroke risk as well.

These are very sobering results, but let’s try to understand the “whys” of this study. As I see it, any infection in the body involves the body’s first immune response, which is inflammation. Now, consider the source of this immune inflammatory response, which in most cases with an oral infection is one form or another of a bacterium. Now consider that, if this specific bacterial infection in the mouth is either absorbed through the mucosal lining of the oral cavity or is able to bypass the gut-associated lymphatic tissue after being swallowed (which occurs throughout the day), then it can pass through the gut lining and be absorbed into the circulation. Now, of course, the “why” journey that I am taking you on is my “educated opinion,” however the mechanism makes sense. This specific infection could then affect the lining of the circulatory system and begin an inflammatory response. The body would try to mitigate this response and perhaps form a plaque or a clot. This in turn could break off or impede the flow of blood to vital organs like the brain and heart and thereby cause the end result of stroke or heart attack. Again, these are my thoughts, but the potential process makes sense to me as an explanation of the connection to stroke, etc.

PERIODONTAL DISEASE

Periodontal disease is one of the most common chronic health problems. It affects about half of adults at some time in their lives. It generally starts with “gingivitis,” which is caused by a bacterial infection, which causes redness of the gums and often causes bleeding when brushing the teeth. Left untreated, this will progress to “periodontitis,” which results in the shrinking gums shrinking and loosening teeth.  

In another study published in the same journal, this one titled “Periodontal Disease Independently Associated with White Matter Hyperintensity Volume; 
A Measure of Cerebral Small Vessel Disease,” the authors focused on small blood vessel disease in the brain and its association with brain health and function.

When smaller vessels in the brain become damaged, we generally do not see stroke events. Instead we see a degradation of the brain’s pathways. These would be early changes in cognitive function that occur before more significant changes in cognition like dementia.

The findings of these researchers were staggering in that individuals in the study who demonstrated gum disease in midlife were 56 percent more likely to demonstrate higher levels of “white matter hyperintensities.” These are tiny spots which indicate microscopic damage to the brain. According to the study’s authors, “These small areas of damage seen in the white matter of the brain are associated with memory loss, balance issues, and slower thinking.”

Here again it is inflammation that is the culprit for the connection with infections in the oral cavity and these changes in the brain. Aligning with what I described earlier, the authors wrote, “Inflammation (from the mouth) is what directly affects those small blood vessels and causes small damages in the white matter pathways.”

WHAT TO DO

So, what can be done about all of this, and how can we mitigate the cause of these issues? 

The first thing that I must recommend is to start and maintain a good oral health routine and regularly clean your teeth. In my opinion, it is the most important thing that you can do. I recommend that you use a good quality mouthwash first, before brushing, to kill off some of the bacteria. Then brush. Using an electric toothbrush is best. Spend some time on the gum lines and gently brush the gums, tongue, and the roof of your mouth. You can then either use dental floss without going too deep into the gums, as this could potentially push bacteria into the gums. You could also use a water pik type of instrument, however here again we don’t want to drive any material into the gums, so care must be used with this as well. Once you are completed with the process you could once again rinse with mouthwash.

Secondly, have a complete oral exam performed, one in which each tooth at the gum line is evaluated. This involves measuring the distance between the tooth/gum level and the depth of the area that can be measured below the gum line using a metered probe. This helps to determine if you are developing what are called “pockets” in the tooth gum interface. These pockets are areas of accumulation of bacterial infection, which cause further damage to the gum, tooth, and eventually to the bone. 

If you are diagnosed by your dentist with “periodontal disease,” then you must have this cared for, which might involve deep cleaning, scraping, or further surgical procedures to evacuate the area of infection and to allow for healing of the gums.

Finally, get regular dental checkups and evaluations with cleaning as necessary. These checkups truly are preventative medicine.

I know that this all sounds like a lot and may be more time-consuming than what you are currently doing. However, if you were to do the cleaning procedure I described twice daily, you will reduce your likelihood of experiencing a stroke or major cardiac issue years from now. And as you know, our goal here at the Center for Nutrition and Wellness is to support prevention and not wait until emergency measures are necessary. So please consider spending the time now on caring for your teeth and in turn, caring for your heart and your brain. You can then feel confident that this positive habit and lifestyle will invariably create a path to a longer, healthier life.

Dr. Pfeiffer